title: Clinical features and treatment responses in pediatric lymphocytic and collagenous colitis.
abstract: OBJECTIVE
  Microscopic colitis (MC) is prevalent in adults investigated for chronic watery diarrhea, yet characterization of pediatric MC is limited.
  
  
  METHODS
  Our pathology database was searched from 1995 to 2011 for pediatric cases of lymphocytic colitis (LC) or collagenous colitis (CC). Those with diarrhea persisting for >2 weeks and visually normal colonoscopy were accepted as cases. Demographics, laboratory results, medication use within 3 months of presentation, medical and family history of autoimmune disease, and response to treatment were abstracted.
  
  
  RESULTS
  A total of 27 cases were histologically consistent with MC on biopsy; 5 with concomitant enteric infection or isolated abdominal pain were excluded. Twenty-two cases of MC (female patients, 59%; median age at diagnosis, 15.3 years) were included (19 LC and 3 CC). Two had type 1 diabetes mellitus, 2 were anti-nuclear antibody positive, and 2 had common variable immunodeficiency. Of 20 patients who underwent an esophagogastroduodenoscopy, 1 had collagenous sprue and 4 had celiac disease. One presented after the clearance of recurrent Clostridium difficile infection. Previous drug exposures included nonsteroidal anti-inflammatory drugs (n = 7), proton pump inhibitors (n = 6), and selective serotonin reuptake inhibitors (n = 3). Common symptoms in addition to diarrhea included abdominal pain (77.3%) and weight loss (27.3%). Of 17 patients with follow-up, all of the 8 treated with steroids had some response: 57.1% (4/7) responded to mesalamine and 42.9% (3/7) responded to bismuth subsalicylate.
  
  
  CONCLUSIONS
  In this cohort of pediatric patients, LC was much more common than CC. As described in adults, we observed associations with celiac disease, type 1 diabetes mellitus, and medications; we additionally saw an association with immunodeficiency. Our patients showed greater response to steroids than mesalamine or bismuth.
authors.affiliation: *Mayo Medical School †Department of Anatomic Pathology and Laboratory Medicine ‡Division of Gastroenterology and Hepatology §Division of Pediatric Gastroenterology and Hepatology Mayo Clinic, Rochester, MN.
authors.forename: Nirmala P
authors.initials: NP
authors.lastname: Narla
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Smyrk
authors.forename: Darrell S
authors.initials: DS
authors.lastname: Pardi
authors.forename: Jeanne
authors.initials: J
authors.lastname: Tung
mesh_terms: D015746:Abdominal Pain / Q000209:etiology / Q000517:prevention & control; D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D000930:Antidiarrheals / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D046729:Colitis, Collagenous / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology / Q000503:physiopathology; D046730:Colitis, Lymphocytic / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology / Q000503:physiopathology; D003106:Colon / Q000187:drug effects* / Q000276:immunology / Q000473:pathology; D003967:Diarrhea / Q000209:etiology / Q000517:prevention & control; D004351:Drug Resistance; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D059012:Lost to Follow-Up; D008297:Male; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012189:Retrospective Studies; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D015431:Weight Loss / Q000187:drug effects
chemical_list: D000893:Anti-Inflammatory Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000930:Antidiarrheals; D054328:Proton Pump Inhibitors; D017367:Selective Serotonin Reuptake Inhibitors